blood pump stopping

  1. Would like to hear from FMC nurses - What is your procedure for 2008K after medication administration.

    One of our machines blood pump stopped, after RN gave medication. The patient received almost 800cc infused saline during this time. (while blood pump was not working).Please explain. The charge RN (different RN) added time and increased UFR rate to adjust that fluid infused .. Thank you.

    Also, how does the Phoenix machine differ in this respect. Thank you.
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  2. 13 Comments

  3. by   DeLana_RN
    Hi,

    I don't work for FMC, but do use Fresenius machines (H & K) in my acute setting; I'm still new, and much more familiar with the Cobe machines I used to work with in the past, but the principle is the same (the most confounding thing about Fresenius machines are actually the blood line with 3 parts and all those clamps I forget to clamp! )

    Basically, the NS infusion has nothing to do with a stopped blood pump. NS will infuse if you forget to clamp the saline clamp(s), as may happen - for instance - when you restart the machine after infusing a few cc of NS after the blood pump stops for high AP (and, more likely, at the beginning of tx if you just forgot to close the clamps). If the clamps are open while the blood pump is stopped, NS can infuse through the arterial line via gravity.

    This happens (it just did to a coworker with 8 years experience! She gave a few cc of NS to restart the machine, and 700 cc infused). She was able to increase the UFR without having to extend the tx time since there was enough time left and the pt tolerated the higher UFR; otherwise, she would have added time as well.

    HTH!

    DeLana

    P.S. I only know this much about the Phoenix machine: our local DaVita clinics are replacing their depreciated Cobes with Fresenius (yes, the main competitor's) machines; they don't consider the Phoenix to be safe. Imagine that!
    Last edit by DeLana_RN on Feb 20, '07
  4. by   LPN2RNBSN
    Yes, the unclamping caused patient to receive close to 600 or more saline. But, I was under the impression, from RN, that the lines needed to be changed when clotting occurred -The staff person who corrected problem did not change lines?
  5. by   DeLana_RN
    Quote from LPN2RNBSN
    Yes, the unclamping caused patient to receive close to 600 or more saline. But, I was under the impression, from RN, that the lines needed to be changed when clotting occurred -The staff person who corrected problem did not change lines?
    I'm not sure I understand. The patient received 600 cc NS because the nurse had tried to clear clotted lines with saline (this is sometimes done)? If so, you don't necessarily have to change the lines if the saline has corrected the problem. Of course, you wouldn't normally use this much saline - 100 cc is sufficient if used to prevent clotting - because it would only take about 300 cc to return (or rinse back) the pt's blood; and if you have returned their blood, then you should change lines - and dialyzer (use a dry pack if you have reuse) - before tx is resumed.

    I hope this didn't make everything clear as mud

    DeLana
  6. by   LPN2RNBSN
    After speaking with the RN she did not clamp off the saline and pt received the 600, or so. The pump stopped after administration of medication, alarm went off but more intervention needed than just resetting and pump restarting. The lines, at this time, were not changed but air withdrawn via syringe, etc. hope that clarifies.
  7. by   DeLana_RN
    Apparently the saline bag ran empty and air infused... that's the likely reason why air needed to be removed from the lines. Or it may have happened during med administration. But I may be wrong.

    Anyway, if you just have to clear air out of your system, disconnecting the pt (flush CVC ports or fistula needles with NS to keep them patent) and recirculating the blood for a few minutes will safely so do; then reconnect the pt and resume tx.

    DeLana
  8. by   LPN2RNBSN
    Delana, thank you. There seems to be different ways staff perform practices. But with one RN how can there be true supervision?
  9. by   DeLana_RN
    That's exactly what makes outpatient dialysis so challenging... and often frustrating. However, try to convince the large providers that they should hire more nurses

    DeLana
    Last edit by DeLana_RN on Feb 23, '07
  10. by   LPN2RNBSN
    Seems that many patients provide information on how they feel, providing information on how much they want taken off. These are those patients who are educated, have been educated on s/s, EDW, etc. However, with only one RN and at times two, it is unrealistic for the RN to assess each patient, esp in a busy unit. This is a problem as I see it esp with techs who do not have medical experience or know each individual patient's medical problems, comorbid conditions etc. Another problem I am noting is that all machines are set with same BP parameters. I am finding alot of care issues that are of concern. One in particular is that labs drawn on third shift patients, especially post draws, are not picked up until the morning, including labs such as blood cultures. This to me is not good business practice and for sure not good medical practice in light of certain labs will be detained 12 hours or more.
  11. by   DeLana_RN
    Our Saturday labs wouldn't get picked up 'till Monday - I guess that's how it's done everywhere (of course no routine labs, these were, for instance, CVC exit site cultures). In general, if they are handled correctly - in fridge, or not, depending - it shouldn't matter, except you won't get your results as quickly as in the hospital.

    Outpt dialysis often reminded me of assembly line nursing (like med/surg), too many pts, not enough licensed staff, not enough time to get it all done

    DeLana
  12. by   LPN2RNBSN
    Oh DeLana, you are ever-so accurate in your perception ab out assembly line nursing. I find is 'shameful' that the dialysis industry can not afford to have labs picked up in a timely fashion. If a patient needs a blood culture and is on third shift on friday.. the labs get picked up next morning... as you say.. if blood cultures done saturday they are picked up on monday. Now, if they were to be picked up on Saturday the unit could, at least, have a preliminary, or even the 48 on Monday when patient returns. This is, in my estimation, neglectful care on part of the industry. It is not, my understanding, up to the individual facility but is a corporate decision. Doesn't anyone realize how important this is? Goodness. What about the patient who has lab done for K+ on Saturday and the result is not in in time for his/her treatment on Monday? What is wrong with this picture? I truly get disgusted at the corporate mindset with many aspect of this life supporting treatment
  13. by   roseynurse345
    Outpt dialysis often reminded me of assembly line nursing (like med/surg), too many pts, not enough licensed staff, not enough time to get it all done

    You are so right!!! That is why I getting out of outpatient dialysis!!!!!!!
  14. by   DeLana_RN
    Quote from LPN2RNBSN
    What about the patient who has lab done for K+ on Saturday and the result is not in in time for his/her treatment on Monday? What is wrong with this picture? I truly get disgusted at the corporate mindset with many aspect of this life supporting treatment
    If it's a routine K+ level, as in monthly labs, it's no different from the other delayed lab results and really shouldn't affect the pt's next dialysis. But if it's because of a missed tx due to clotted or nonfunctional access, a stat K+ level should be done; we used to send the tube to the local hospital and call the nephrologist and/or vascular surgeon with results.

    DeLana

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